Prevention Vs. Cure...
(aka Proactive Vs. Reactive)
((aka Present Responsibility Vs. Future Response))
"An ounce of Prevention is worth a pound of Cure" (as the old expression goes...)
Observation: Most health insurance policies today, whether they are government or private corporation, national or regional, are based on the idea of paying for medical/health problems AFTER the onset of the health problem...
Prevention, preventative health, preventative medicine, and preventative programs -- would not only do a lot to preempt future health problems, but it would also save a ton of money (a ton of taxpayer money if the health insurance is a government sponsored one), as the above article so eloquently makes clear!
Observation: Some insurance policies do include some preventative health aspects -- but as medicine is complex and there are always new discoveries, there is always another step up, another higher level in what could be delivered...
In other words, these could always be improved...
"An ounce of Prevention is worth a pound of Cure" (as the article implicitly suggests...)
Anyway, great article!
>Observation: Most health insurance policies today, whether they are government or private corporation, national or regional, are based on the idea of paying for medical/health problems AFTER the onset of the health problem...
There's a lot wrong with health insurance in the US but this problem is largely on providers, not payers.
Insurance claims submitted by providers are effectively itemized using standardized Current Procedural Terminology (CPT) codes. Those codes are written by the American Medical Association (AMA), the lobbying group for physicians. Doctors make more money when services are expensive and require a doctor to be involved. As a result, reimbursable services tend to be reactive (i.e. more lucrative), rates have a tendency to go up, and CPT codes tend to favor reimbursing for physician time rather than patient outcomes.
In fact, there's a whole category of preventive health companies (e.g. Virta) that sell to insurers because the insurance companies bear the financial risk and benefit from a healthier member base. Insurers will pay for these programs on their members' behalf and try to get them to enroll so they don't have more expensive problems later. Providers make a lot less money when prevention works.
I don't think it's some grand conspiracy by evil doctors, just incentives gradually reinforcing bad patterns at scale.
Some excellent points!
>There's a lot wrong with health insurance in the US but this problem is largely on providers, not payers.
How would you fix it?
You need to decouple care from labor as much as possible or you'll just end up trading off between cost and quality without meaningfully moving the frontier.
Healthcare in the US is mostly gated on physician labor. Physician labor is scarce. Scarce labor is expensive.
Physician labor shows negligible productivity growth over time. Wages have to increase to compete for labor against high productivity growth sectors (e.g. software). On top of that, institutionally managed bottlenecks on labor supply prop up high wages (e.g. limited residency slots artificially constrain the number of doctors entering the market). Training more doctors would supposedly compromise patient safety because it would mean lowering the bar for admissions and straining existing staff that need to train them. Even if you could admit and train them all, supplying enough doctors to meet market demand would cause a wage collapse breaking the ROI of med school expenses. So the labor is not going to get cheaper.
So care requires labor that's expensive and only getting more expensive. If you want to reduce the cost of care without reducing the cost of labor, you need to deliver more care per labor-hour (i.e. get more efficient). Provider orgs that employ doctors try to boost efficiency by squeezing every last ounce of time and energy out of their doctors and booking impossibly full schedules. They have a strong incentive to make this work, yet the doctors get only marginally more efficient (and way more burnt out).
To meaningfully move the cost/quality frontier, the majority of care cannot be handled by a human.
8VC laid out a vision [0] that I strongly recommend reading and mostly endorse. It's a long series of hard technical problems but I think the harder problem is actually winning over the institutional gatekeepers (FDA, state medical boards, CMS, AMA). I can't tell exactly what doctors are supposed to do in this envisioned future but the answer will have to be something that sways the gatekeepers even if it's not what's best for patients.
[0] https://8vc.com/resources/ai-healthcare-vision
A series of excellent points!
Hopefully future healthcare policy makers (both in the public and private sector) will read them, and get some good advice from them...
>"Training more doctors would supposedly compromise patient safety because it would mean lowering the bar for admissions and straining existing staff that need to train them. Even if you could admit and train them all, supplying enough doctors to meet market demand would cause a wage collapse breaking the ROI of med school expenses."
There seems to be a vicious circle in place between too much medical regulation requiring a corresponding amount of long and expensive education, and the high cost of medical education in general...
Which one is cause and which one is effect I do not know...
It would seem to the casual observer, that both aspects might feed into one another...
One thing I do know is that doctors from foreign countries, especially if they are third-world countries, typically have had to pay less, sometimes a whole lot less, for their medical education, compared to their U.S. counterparts...
Is that medical education as good as a U.S. medical education? Well, I don't know! Maybe it is in some cases, maybe it isn't in others...
What is known though is that foreign medical educations frequently cost less, sometimes a whole lot less -- than their U.S. counterparts...
Is hiring foreign doctors the solution or part of the solution?
I don't know that either, but I do know that there are a lot of foreign doctors (and previously foreign doctors before becoming U.S. Citizens) in the U.S., and certainly many more abroad...
Is AI the solution, or part of the solution?
It's definitely a wildcard with promise at this point; it'll be interesting to see where it goes in the future...
Anyway, you make some excellent points!
Hopefully future policy makers will read them and act on them...